Cellulite: diagnosis and causes

Unpleasant consequences: wrinkled skin with internal irregularities and nodules that appear due to lack of elasticity of connective tissue and encapsulation of damaged adipocytes of the dermis. This may appear as dimpled or orange-peel skin if the skin is thin.

How does cellulite occur?

Adipocytes are found in adipose tissue and are held in place by connective tissue fibers, which act as a support network. An increase in their size or number leads to excess fat accumulation and water retention. This increase may be caused by overeating, lack of exercise, hormonal imbalances, or a combination of these factors.

The accumulated adipocytes compress both the supporting fibers and the capillaries of the connective tissue, thus reducing blood flow. When there is a lack of oxygen (asphyxia), fat cells form nodules (fat cells are surrounded by a membrane), which appear under the epidermis and can be visually diagnosed.

Arteries carry oxygenated blood, water and nutrients throughout the body, and they connect to a wide network of extremely small, single-cell-thick blood vessels called capillaries. Capillaries are responsible for releasing oxygen and nutrients carried by the blood into cells. Also in these capillaries, the absorption of metabolic products into the blood occurs, and before entering the heart, this blood passes through a network of veins. When capillaries are clogged, living cells cannot function normally.

The formation of cellulite can be associated with many reasons or their combinations, but the most important of them are the following:

• Hormonal factors: Excess estrogen and progesterone determine water retention and can cause imbalance in adulthood, pregnancy or premenopause. Excessive intake of prostaglandin into the blood increases capillary permeability and leads to an imbalance in the pituitary-adrenal system, the glands of which increase the secretion of the stress hormone cortisol;
• hypothyroidism: hypofunction of the thyroid gland slows down metabolism, at the same time there is an increase in the level of insulin in the pancreas, which responds to food digestion by increasing lipogenesis with the accumulation of fats in adipocytes;
• national factors: Caucasian women are undoubtedly more prone to unaesthetic manifestations associated with cellulite than women with darker skin;
• anxiety: nervous women experiencing emotional distress or depression are more easily susceptible to the phenomenon of cellulite, since stress determines the neuroendocrine response, which results in water retention;
• nutritional factor: too fatty or salty foods (salami, chips, cakes), as well as alcohol and carbonated drinks complicate the problem of cellulite. Excess salt leads to increased water retention by the body. However, a balanced, healthy diet based on fruits and fresh vegetables containing plenty of fiber will slow down the absorption of fat and carbohydrates as they pass through the intestines;
• physical activity: lack of physical activity and air pollution (including smoking) are the two most important factors in reducing respiratory (breathing) activity. This means that the actual amount of air entering the lungs is very small compared to what is needed. Decreased excursion of the chest wall and diaphragm in sedentary subjects results in slower blood flow toward the heart, which in turn results in decreased capillary blood flow;
• genetic factors: people with genetically determined slow circulation have problems removing metabolic products from the cell into the venous blood, which returns to the heart. According to statistics, women are more likely to experience circulatory disorders - mainly due to hormonal reasons and a sedentary lifestyle.

Possible damage to the circulatory system caused by cellulite:

• increased capillary permeability (i.e. hormonal changes);
• increased intracapillary pressure;
• violation of lymph circulation.

Such damage will increase swelling and water retention, which means that excess fluid that is normally absorbed and excreted by capillaries will also be retained in the spaces between fat cells. These fluids may contain lipid thickening toxins. This decrease in blood flow can also reduce body temperature, especially in the hands and feet.

Edema usually forms when excess moisture is retained. The presence of edema, in turn, has a negative impact on the normal circulation of lymph and the functioning of adipocytes, which creates a complex of negative situations that manifest as thickening or “orange peel” skin. Quite often this is accompanied by a feeling of fatigue and irritability, which is caused by improper lymph circulation.

Classification of cellulite

Hard cellulite

It usually occurs in young women, usually with good muscle tone. This compact formation, closer to the deeper layers of the skin, is sometimes accompanied by numbness or lack of tactile sensitivity. Predominantly the buttocks, knees and outer thighs are involved. The skin is rough and dry, although the epidermis looks transparent and delicate.

Cellulite masses are not mobile and do not increase in folds. Squeezing during the examination may be painful, and the hands and feet may sometimes feel cold. Venous circulation may be weakened by superficial varicose veins and telangiectasia (“spider veins”).

Soft cellulite

The surface layer is flabby and separated from the underlying tissues. Often covers larger areas, especially the inner thighs and arms. This category is usually caused by rapid weight loss. Cellulite moves during vibration and the tissue retains a lot of fluid.

Edematous (edematous) cellulite

This is a type of soft cellulite with more water in the tissue. Most often located on the lower extremities and is accompanied by varicose veins and damaged or thinned capillaries. Sometimes you can find areas of edema or soft cellulite with inclusions of hard cellulite.

The classification of cellulite by histological changes, which was proposed in 1979 by SB Curri and JF Merler, has found the greatest practical application. They described 4 stages of cellulite development.

• Stage 1: changes occur in the affected areas caused by stagnation of the interstitial fluid between the cells (“soft” cellulite). The fluid compresses the lymphatic vessels, as a result of which the outflow of lymph is disrupted, which is reflected in the appearance of local swelling.
• Stage 2; the reticular connective fibers located around the adipocytes become compacted and hardened, complicating the circulation of blood and lymph at the capillary level. More pronounced swelling forms. The functioning of the lymphatic system in the affected area is reduced to 30-40%. The venous system also cannot cope with the outflow of fluid, as the post-capillaries are compressed. In this regard, the pressure inside the tissue increases. There is an increase in the size of adipocytes with a predominance of lipogenesis. When pressed, marks remain on the skin (Poppo symptom), the skin loses its elasticity.
• Stage 3 (micronodular): liposclerosis develops. Micronodules are formed, and, as a result, the “orange peel” symptom (“hard” cellulite) appears.
• Stage 4 (macronodular): characterized by an increase in the number of micronodules, which increase in size, forming macronodules.

Rice. 1. Normogram

Fig..2. Cellulite stages I and II: “motley spots”

Rice. 3. Stage III cellulite; "leopard spots"

Rice. 4. Stage IV cellulite: “black holes”